Hi @Dr_Cole . Thanks for your detailed and thoughtful answer. But I just don’t see how harvesting perifollicular adipose can be a realistic answer to anything. Where will this be harvested from? It seems to me, just as healthy terminal hair follicles are in short supply on the average balding man’s head, so is perifollicular adipose. Will you be harvesting it from the legs, beard, and other places, along with the scalp? Because, just as the bottom line of hair transplantation has always been limited by donor supply of follicles on the scalp, I think you’ll hit the same brick wall with a limited donor supply of perifollicular adipose in the scalp. The only valuable adipose tissue will be around healthy growing terminal follicles.

You’re saying hair follicles develop as a combination of ectoderm and mesoderm which is very true. Then you said that adipose tissue comes from very far from mesoderm – I assume you mean most of it comes from endoderm (the most inner portion of the developing embryo). First, I don’t think it matters where the adipose tissue comes from – what you need is the chemical signaling expressed by stem cells within the adipose tissue. This would be generally the same type of signaling whether the adipose comes from the vicinity of the follicles, or from abdominal adipose. (If you disagree with this, do you have any citations of studies which says otherwise?) Second, adipose tissue actually comes from both endoderm (a small amount) and mesoderm – in fact, PRIMARILY from mesoderm. Please see the following article which says it comes from mesoderm:

So, if we go by what it says in that article, and you think it’s important for adipose signaling to come from mesodermally-derived fat (because of the mesodermal connection with the hair follicle), then any fat should do, including abdominal fat.

Adipose is an excellent source of stem cells. The number stem cells in adipose derived SVF is enormous. In theory, pluripotent cells should be able to differentiate into hair follicles. Thus far, I have not seen any evidence that adipose will increase hair counts. I think you are probably right about signaling. We need some initiator to get the stem cells to begin differentiation into follicles. My theory on where the adipose comes from is simply an argument to try something new because what we have done until now is not working. There is the para-axial mesoderm, the intermediate and the lateral mesoderm. The lateral gives rise to adipose and the para-axial to the dermis. We can harvest perifollicular adipose from the abdomen, scalp, beard, underarm, or anywhere there is hair. This mesoderm is better suited perhaps because there is an interaction between the follicles and the adipose. We did two cases at FUE Europe in Ankara in May. We also harvested and injected follicle stem cells. Furthermore, we activated with Acell. So hopefully we will have something to report.

Dr. Cole You’re on my short list of USA doctors I plan to meet with when a breakthrough treatment hits the USA market.

The USA Kerastem-Team should release data in a few months. Their team includes Dr. Washinek. If they report increased hair counts in their USA FDA phase 2 study are you going to accept those results or are you going to reject those results?

I’m sure Kerastem will come out with positive results. But one thing is “proof of scientific concept”, another - regrowing significant amount of TERMINAL hair.
Let’s remember that even to date minoxidil manufacturers and sellers are allowed to label minoxidil as hair regrowing substance.
If that was a case, why we would need to discuss Replicel, Sischeido, Tsuji or Folica?

There is going to be a great meeting in Japan at the end of October. I think this session will let us know where we stand at the moment. The great minds will be there. Dr. Washinek is a great guy. He is probably the best addition that Bosely could make. The problem is that he does not fully understand hair transplant surgery. He is brilliant and an excellent statesman. I look forward to his results. However, I will need to scrutinize his data because very few know how to study the response of hair to medical and cell based therapy. You have to be in the trenches to know how. However, jarjarbinx, I am fully prepared to accept any positive results with real science behind it. If the data is based on trichoscan or photography, the results will not be valuable. You have to dig deeper to get accurate, objective data.

Dr. Cole, if Kerastem gets positive but unspectacular results I’m wondering what you might be able to do to make the Kerastem treatment better. I ask because the recent Kerastem study posted at this site reported a 20% increase in hair but the pics showed only a small visible improvement. This means that 20% more hair on a balding scalp really doesn’t result in substantial visible improvement.If Kerasem does improve hair counts by 20% can you augment the treatment for additional improvement on top of that 20%?